It was bound to happen and not particularly difficult to predict — fewer doctors in the nation want to participate in Medicare and Medicaid.

To be specific, the number of doctors who opted out of Medicare last year, while a small portion of the nation's health professionals, has tripled from three years ago according to the Centers for Medicare and Medicaid. Other doctors are limiting the number of Medicare patients they treat even if they do not formally opt out of the system. And, we have known for a long time that most Texas doctors do not participate in Medicaid (31 percent participate). This is an ominous situation — fewer providers at a time when millions of Americans are supposed to gain health care coverage under the Affordable Care Act.

By now, you are familiar with how the Affordable Care Act is supposed to work. Americans with incomes from 138 percent to 400 percent of the federal poverty level will qualify for subsidized private coverage through the state exchanges and those below hundred 138 percent of poverty will qualify for an expanded Medicaid program.  In short, if ACA works as projected, we will have more people with coverage, but it appears we may have few providers willing to see them as patients. A new year is just around the corner and it is to be the year when many of these changes are scheduled to happen.

Texas Tech Physicians gladly accepts both Medicare and Medicaid patients.  Will we see demand for our services increase next year?  Possibly. And then the question becomes, “are we prepared to handle the increased volume?”  Our clinical visits this year are up a little, year to date through June; compared to last year, we moved from 220,305 to 220,927 clinic visits (0.3 percent).  That does not answer the capacity question — just tells us how this year compares to last.

We want to be part of the solution to the challenges before us. To be forewarned is to be forearmed, or put another way: Those who know that something is coming are better prepared to face it than those who do not know.